Laparoscopic staging of peritoneal surface malignancies

Background The Peritoneal Cancer Index (PCI) may be used in the intraoperative evaluation of peritoneal surface malignancies to estimate the feasibility of peritonectomy with intraperitoneal hyperthermic chemotherapy perfusion. Although radiologic imaging techniques detect liver and other distant metastases, they do not accurately image small cancer implants on small bowel and its mesentery, thus making a CT-PCI classification impossible. Results We used videolaparoscopy to stage 97 cases of peritoneal carcinomatosis, and achieved full laparoscopic PCI assessment in 96/97 cases, while only 2/96 cases were understaged. In all our cases where peritonectomy followed diagnostic laparoscopy, we found good correlation between the open surgery data and the laparoscopic PCI. There was no mortality and no neoplastic colonization at the trocar port site. We excluded patients from peritonectomy if the staging laparoscopy showed a massive involvement of their small bowel or mesentery. Conclusion Laparoscopy is a useful tool in peritoneal surface malignancies; it allows direct visualization even of small cancer nodules and provides a reliable assessment of the feasibility of peritonectomy.